Pelvic organ prolapse

About

Pelvic organ prolapse is a condition where one or more of the pelvic organs (uterus, bladder, urethra, rectum) drops downward into, or out of, the vaginal opening. The organs that protrude are the uterus, bladder, urethra, small intestine and rectum. Pelvic organ prolapse is a common condition that occurs in women after childbirth when the pelvic floor muscles and connective tissue are weakened. Most women with pelvic organ prolapse experience no symptoms, however some women may experience urinary or fecal incontinence, pelvic pressure, a feeling of heaviness in the vagina, and pain during sex. Treatment may include lifestyle modifications such as Kegel exercises, medical devices such as pessaries, or surgery.

Symptoms

The most common symptom of pelvic organ prolapse is a bulge or protrusion of tissue near the opening of the vagina. Other symptoms include feelings of pressure or fullness in the pelvic area, discomfort when standing or walking, lower back pain, discomfort during sex, and urinary or fecal incontinence.

Causes

The most common causes of pelvic organ prolapse are weakened or stretched pelvic floor muscles. This can be caused by childbirth, menopause, hysterectomy, genetics, chronic coughing, straining to evacuate stool, chronic constipation, and heavy lifting. Other risk factors can include being overweight, smoking, and pelvic radiation therapy.

Risk factors

The major risk factors for pelvic organ prolapse include having had multiple vaginal births, having a weak pelvic floor, being over the age of 40, being overweight, having chronic constipation, having a family history of the condition, having given birth to a large baby or a breech presentation, chronic coughing or sneezing, having undergone a radical hysterectomy, and participating in activities that involve increased abdominal pressure, such as straining with bowel movements, lifting heavy objects, or straining during physical activities. Other risk factors include a prior pelvic surgery, a connective tissue disorder, such as Ehlers-Danlos Syndrome, and being menopausal or postmenopausal.

Diagnosis

Pelvic organ prolapse is typically diagnosed during a gynecological exam. During the exam, the doctor will check the strength of the pelvic floor muscles and assess the size, shape, and location of the prolapse. Imaging tests like an ultrasound or MRI scan may be ordered to get a better look at the pelvic organs. These tests can help diagnose the specific type of prolapse and determine whether there is any other damage to the pelvic organs. The doctor may also measure the amount of prolapse to determine the severity of the condition. Finally, a urodynamic test may be used to measure the function of the pelvic floor muscles.

Sub-types

There are four main subtypes of pelvic organ prolapse (POP): anterior prolapse, apical prolapse, enterocele prolapse, and rectocele prolapse.

Anterior prolapse is the most common type of POP and is caused by a weakness or tearing in the front wall of the vagina. This causes the uterus and bladder to sag downwards and bulge into the vaginal opening.

Apical prolapse is caused by a weakness or tearing in the back wall of the vagina. This causes the uterus, cervix, or upper part of the vagina to prolapse downwards and bulge into the vaginal opening.

Enterocele prolapse is caused by a weakening of the back wall of the vagina and the wall of the intestines. This causes the intestines to bulge down into the pelvic cavity and push the uterus and cervix downwards.

Rectocele prolapse is caused by a weakening in the back wall of the vagina. This causes the rectum to bulge down and push the back wall of the vagina forward. This can cause a bulge in the back wall of the vagina.

Treatments

The treatment options for pelvic organ prolapse depend on the severity of the condition. These options range from conservative treatments such as pelvic floor exercises, lifestyle changes, and treatment with vaginal pessaries, to more invasive treatments such as surgery.

Pelvic Floor Exercises: These exercises are used to strengthen the pelvic floor muscles, which can help to support the pelvic organs and prevent further prolapse.
Lifestyle Changes: Making lifestyle changes such as avoiding heavy lifting, maintaining a healthy weight, and quitting smoking can help to reduce the pressure on the pelvic organs and prevent further prolapse.
Treatment with Vaginal Pessaries: Vaginal pessaries are inserted into the vagina to support the pelvic organs and can help to reduce or alleviate the symptoms of pelvic organ prolapse.
Surgery: Surgery is an option for more severe cases of pelvic organ prolapse. This can involve procedures such as a hysterectomy, sacrocolpopexy, and colpocleisis.

Prevention

To reduce the risk of pelvic organ prolapse, it is important to maintain strong pelvic floor muscles. This can be accomplished through regular pelvic floor muscle exercises, also known as Kegel exercises. Additionally, avoiding activities that put strain on the pelvic floor muscles, such as lifting heavy objects, can be beneficial. If you are pregnant or have given birth, wearing a supportive abdominal wrap during activities may also be helpful. Maintaining a healthy weight, eating a balanced diet, and avoiding constipation can also help reduce the risk of pelvic organ prolapse.

Gender differences?

Yes, there are gender-specific differences in the presentation and management of Pelvic organ prolapse (POP). Women are more likely to experience POP than men due to their anatomy and the effects of pregnancy, childbirth, and menopause, although POP can affect men as well. Women with POP may experience a bulge, heaviness, or discomfort in the pelvis, as well as urinary, bladder, and/or bowel changes.

The management of POP in women includes pelvic floor exercises and lifestyle modifications, such as avoiding heavy lifting, losing weight, and avoiding straining during bowel movements. Women may also benefit from the use of a pessary or surgical repair of the prolapsed organ. For men, the management of POP typically consists of lifestyle modifications, medications to address urinary symptoms, and possible surgery.

Nutrition

Nutrition plays an important role in the management of pelvic organ prolapse. Proper nutrition is important for maintaining good health and supporting the pelvic floor muscles, which can help to prevent or reduce the symptoms of pelvic organ prolapse. Eating a balanced diet full of fruits, vegetables, whole grains, and lean proteins can help to ensure that the body is adequately nourished and the necessary vitamins, minerals and other nutrients are consumed. Eating foods that provide adequate amounts of fiber will also help to support healthy digestion and regular bowel movements, which can reduce strain on the pelvic floor muscles and help to reduce the risk of developing pelvic organ prolapse. Additionally, staying hydrated by drinking plenty of water can help to prevent constipation, which may also aid in reducing the symptoms of pelvic organ prolapse.

Physical Activity

Physical activity can play an important role in helping to manage pelvic organ prolapse. Moderate physical activity such as walking, swimming, low-impact aerobics and strength training can help strengthen pelvic floor muscles and support the tissues around the pelvic organs. Regular exercise also helps to reduce pressure through the abdominal area and helps to improve circulation, which can help with healing. As always, it is important to consult with a doctor or physical therapist before beginning any exercise program, particularly in cases of pelvic organ prolapse.